Update on my husband: Had surgery to remove prostate in 2012, stage 2, negative margins, PSA undetectable
Sept 2019 - PSA rose to 0.2
Met with radiation oncologist and course of treatment is going to be radiation 5x week for 7 weeks. My husband also has atril fibrilation and is also on seizure medication so the oncologist said he will not be taking any medications after radiation due to other health risks.
He is going to have a CT scan to plan the radiation on the 23rd but doctor said since his PSA is so low (0.2), the doctor thinks it has not metastasized. He said that his PSA would be in the 100's if it has metastasized.
Any comments are appreciated
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bigpapajd
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I agree that your husband is getting the correct advice and treatment. He’s having salvage treatment before his PSA rises too far, and given his history, hormone therapy would be a line ball call - his cardiac issues make that an easy call.
Chances are good that the treatment will achieve a lasting cure for him - if not, then in a couple more years he will be able to a PSMA scab (should be widespread in even the US by then!) and have SBRT to knock off any local recurrences.
The only question I would ask theRO is if he plans to treat just the prostate bed or the lymph nodes - given no HT, I would push him to widen the field and treat the nodes.
I agree with you. I had the same situation, didnt do ADT and the SRT to the prostate bed only failed in 6 months and the psa started to rise. I did SRT at .07 psa and still failed. If I had to do it again, I would treat the nodes also. Lots of luck
You don't say but if your radiologist is doing SRT to the prostate bed only then you may want to ask a few more questions. The Axumin scan is a starting point, a conventional CT is likely not sensitive enough at PSA .2.
You may want to inform yourself and ask about micro-metastatic PCa and should you do combination therapy, adding some ADT for a period, that could be six months of Lupron. Another thing to ask is should the treatment field be extended to include the PLNs. Awhile back Mayo had data that showed with BCR as in your case (and mine) SRT to the prostate bed only more often missed distant sites of recurrence in the PLNs.
SRT to the prostate bed only may work for your husband (my personal experience is it does not because of micro-metastatic disease), not knowing age and clinical data such as GS, and not being a qualified medical person I can only offer that you should ask a few more questions of your medical team.
Another thing to consider is having another lab or two to gauge PSA doubling and velocity time, that may aid in the decision making, a more aggressive disease will have PSADT < six months.
The challenge is SRT to the prostate bed is generally more successful at lower PSAs so waiting to get multiple PSA tests over time to determine doubling and velocity times is contrary to possible success if the recurrence is limited to the prostate bed. Same for imaging, higher PSA increases visibility of recurrence but then it may have spread to pelvic lymph nodes, organs or bones.
At PSA 0.2, I don't think a CT scan or bone scan will anything yet. A PSMA pet scan may be the best bet first. There are several US trials offering these, or you can go to Germany and have one done first.
With a low PSA you have the luxury of TIME to do some experiments before using "sledgehammers on tacks". His heart problems could be electrolyte imbalances - eliminate that possible cause. Do whatever you can to tighten down his diet to more raw foods and eliminate sugar and stuff in packets or bottles. Diet alone may give him many more years.
When a good diet needs an assist, use Sodium Ascorbate via IV. That can buy a few more years. After that, start looking at "the heavy stuff" that does permanent damage and there is then no turning back. Good luck!
Some supplements I take for a-fib: magnesium citrate, L-Arginine, Co-Q10, L-Taurine. I am also on prescription meds.
The purpose of the CT scan that is being done as part of the radiation planning is not to look for mets but to map the anatomy so that the radiation field intensities can be planned optimally. This is part of conformal IMRT procedures and provides the best information for positioning and planning the radiation for best possible results. They will also likely do a "cone-beam" CT scan at the start of each treatment to exactly position you for each treatment.
I agree that a discussion of adding pelvic lymph nodes to the planned radiation fields should be carefully considered, as that may be a risk area for future recurrence.
Note: I am going through such radiation treatment right now to pelvic lymph nodes. As that is where my recurrence appeared 12 years after RP and prostate bed "salvage" radiation treatment. The current RT technology is so much more advanced now than just 12 years ago at the same institution. I am very happy to have this approach at this time. Best wishes for you!
I've had 39 treatments (8 weeks, 5 days a week minus 1 day). I did NOT have any side effects during the actual "FRYING". However years later it was discovered that my left urinary tract had become scarred/constricted and required many "in and out stents" for my kidney and urine. BTW the in and out of the stents were "a walk in the park". No Pain or discomfort. Rad was done at Memorial Sloan Kettering cancer center in NYC.
Just be wary of the damage that Rad can do (even if it's silent).
P.S. Ask the radiologist for:
SpaceOAR hydrogel is an option for men who undergo radiation treatment for prostate cancer. It acts as a spacer providing space between the rectum and the prostate, making it much less likely that the rectum is exposed to radiation. It is injected into place prior to the start of radiation treatment.
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